Posts by IvoryT 27 publicly visible posts • joined 18 Aug 2015
Not so much medical bronchoscopy, but the real biggie may be the potential contribution to anaesthesia.
Tracheal intubation is normally routine but can be challenging, and failure in some circumstances can be rapidly fatal. Currently it is all relatively low-tech... bring on the 'bots! If this thing can reliably find the vocal cords and poke itself through then I want it in my anaesthetic room.
Dear Virgin, why have you treated the west end of Glasgow so disdainfully? Having had a Virgin account since year dot, I would have loved to switch to fibre, but you refused to fibre the street and instead sold me off unceremoniously to TalkTalk (ditto many others). I have no doubt that I will not be among your lucky "millions".
Unfortunately, the explanation from the doctor you dated is a bit simplistic to the point of being wrong in terms of the electrolyte imbalance. Here's a reference to get you started if you are interested in the actual science behind this. Abstract attached.
Emerg Med Clin North Am. 1990 Nov;8(4):761-73.
Electrolyte abnormalities in the alcoholic patient.
Ragland G1.
Abstract
The acute effect of ethyl alcohol ingestion is to induce diuresis with excretion of free water and preservation of electrolytes. This occurs as the blood alcohol concentration is increasing and is due to the suppression by alcohol of the endogenous release of ADH. During a steady blood alcohol concentration, alcohol acts as an antidiuretic, causing retention of water and electrolytes. While at steady state, additional doses of alcohol will produce progressively smaller and eventually absent diuretic responses. The chronic effect of alcohol is to promote isosmotic retention of water and electrolytes due to increased ADH levels. Excess water and electrolytes are acutely excreted in response to additional alcohol ingestion. With the cessation of alcohol intake, this excess will be excreted over several days. Routine parenteral fluid administration to chronic and withdrawing alcoholics should be avoided. The role of potassium and magnesium in the genesis of specific manifestations of the alcohol withdrawal syndrome is not clear.
The website https://www.brave.com/ hits you with two bits of code running in the background: Chartbeat and Doubleclick advertising (according to Ghostery). So looks like even their own website would load faster in Brave than than in other browsers because that code would be stripped out.
Talk-Talk offered me a choice of two free upgrades
1) a free sim
2) a broadband health-check, where someone would come to the house and check how healthy my broadband was.
I needed neither. Was rather underwhelmed because this had been billed as a substantial upgrade as compensation for my worries and a reward for staying with them.
UK News this morning: 90% of NHS hospitals are unable to recruit enough nursing staff to reach minimum staffing levels on the wards.
Is this the Government response? £1Bn for wifi so patients can self-monitor their health using Apps?
What does this even mean? Say you are in hospital with pneumonia, cholecystitis, heart-failure, diabetic keto-acidosis, a stroke, peripheral vascular disease, appendicitis, etc etc. What the heck are you supposed to monitor with these "Apps" and in what way on earth is that supposed to feed into the medical care you are getting?
"Once upon a time there was equipment that did do weird and not helpful stuff when mobiles were around,"
Theoretical. There were no reproducible cases of this. Occasionally equipment malfunctions, and it is easy to blame new technology. We had a ban on phones on the ITU floor of our hospital because of this meme - but they were freely used on the floors below and above - presumably the effects only radiated horizontally.
I am against the death penalty for all the obvious reasons, but if your country actually has it then laser strikes on planes would be a good candidate because it actually would act as a deterrent.
You would only have to publicly execute 3 or 4 people and and this horribly dangerous behaviour would stop.
The NHS record for IT projects costing >£1million is woeful, with only 25% delivering at all.
For my institution, the successes with appointment saving come from the staff phoning those with appointments the day before (or the friday before the monday) to confirm that they will attend. This reveals the many who did not receive any appointment letter or got a letter with an error on it. Don't expect a new IT system to deliver any savings over the current ones - it is a combination of how they are used, and the psychological/disease profiles of the patient population that limits their effectiveness.
The overall lifetime risk of getting cancer is currently about 40%
Tobacco smoke contains powerful carcinogens, and causes 27% of all cancer deaths. Tobacco causes virtually all lung cancers, and many larynx, oesophagus, mouth, throat, bladder, pancreas, kidney, liver, stomach, bowel, cervix, leukaemia, and ovarian cancers.
Cancer is largely a disease of old age. We live in a carcinogenic world (there are over 200 identified carcinogens in a cup of coffee - all low risk!), but our bodies have effective defences against us developing cancer. These defences become less effective as we get older causing an increased risk of something sneaking in under the radar, or are overwhelmed by a carcinogenic assault like tobacco or HPV.
Over 30% of all oral, oesophageal, stomach and bowel cancers are attributed to dietary factors.
Red and processed meat (including bacon) causes 3% of cancers in the UK.
Alcohol causes 4% of cancers in the UK - with the risk proportional to how much you consume. The type of drink it is in is irrelevant.
White meat like chicken, stress, mobile phones and masts, and plastic bottles do not cause cancer.
So, you can't escape the risk, but it would seem sensible to be informed and avoid or reduce the biggies. As a doctor I intend to have a bacon sandwich for lunch today.
OK, Amazon, now add some appropriate actions (though maybe not immediate full emergency services) to the following requests:
"Alexa, there's an intruder in the house."
"Alexa, my husband, he won't waken up."
"Alexa, we're away for 2 weeks, if you hear anything please record it and alert us"
"Alexa, my daughter has just swallowed 300 paracetamol tablets" (US=acetaminophen)
"Alexa, (sound of ring-pulls) please ignore us until tomorrow morning no matter what we say."
No, not his fault, but an utter IT failure from the ground up. This morning 2 children nearly didn't get treated because of poor IT provision. We can get PACs in one room, but it falls over in the other. Though email is the opposite way round. Clinical staff now well used to: program fail (today on fresh boot with a single click ... "Unable to load Carestream, instance already loading, please wait."). What to do? Some now go instinctively to task-manager to shut down the offending processes, or reboot and have another horrible wait. Dear medical software writers, you charge enough - why not write your software so that on close it cleans up its memory footprint,
In theatre, once we get a PACS x-ray on screen to guide an operation, it ruddy times-out and we need to get theatre staff to sign in again. We have asked till we're blue in the face to get the time-out increased so we can at least do an operation uninterrupted, but it seems to be beyond our IT dept to do this. I could go on and on, as a computer-literate clinician I am simply embarrassed at how appalling our medical IT provision is.
Once IT begins to get its collective act together, then I might accept this slagging-off of my clinical colleagues. Until then ...
It's a convention - Surgeons do not say thank you for items given to them during an operation. That's not because they are impolite, just that they may need hundreds of items passed to them during an operation and to formally say "thank you" every time would make operating unworkably slow. Maybe you think the full "you're welcome", or "no trouble, don't mention it" should be added every time.
As an anaesthetist, the same applies. Apart from the occasional "ta", I thank my anaesthetic nurse at the end of a busy list, they would not thank me for slowing their day down.
Well as a doctor in a very large new hospital in the UK we are faced with the following: a network that can take 20 minutes to give you a working computer after sign-in. We have to carry a hospital Blackberry, an internal phone, a pager, a proximity card for doors, a separate proximity card for labour-ward emergencies, a third proximity card for one of the theatres, a card with a single-sign-in thingy, a hospital laptop. We are faced with hardware boot-up passwords, then multiple system access passwords all with different periods of password-ageing so you can't keep them in sync. When we phone IT help desk about anything they try to break any request down into multiple jobs each of which is given a job number (we presume they charge per job) - even for requests that could be easily and instantly dealt with over the phone. Regularly a password which works one minute will refuse to work an hour later needing a phone call (we keep our enforced multiple passwords written down otherwise our jobs would not be possible). We have completely different usernames for the systems we access (I mean, good grief!!!).
In short it is a monumental, embarrassing IT mess, but hey have a bit of fun at a doctor's expense.
"That's 30 per cent growth in a week, a lovely result, but rather less than the 177 per cent jump in the previous week, when the OS went from 1.36 per cent to 3.78 per cent."
Comparing percentages? But Win 10 take-up should be linear, not exponential. So 2.42% increase prev week, compared with 1.17% this week. A fall, yes, but not quite so dramatic.
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